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ADHD Medication During Pregnancy and BreastfeedingThe choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Physicians don't have the data to give clear advice, but can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct case classification and to limit the possibility of bias.
However, the study had its limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the underlying disorder. This makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to the use of medications, or if they were affected by co-morbidities. In addition, the researchers did not look at the long-term effects of offspring on their parents.
The study did find that infants whose mothers took ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk of admission was not found to be influenced by the stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean birth or having a baby born with low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages could be offset by the greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, assist them in developing strategies to improve their coping abilities that can lessen the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other physicians and the research on the topic.
In particular, the issue of possible risks to the infant can be difficult. A lot of studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion: While some studies have revealed a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. The majority of studies show a neutral, or even slight negative effect. Therefore, a adhd stimulant medication careful risk/benefit assessment is required in every instance.
For women suffering from ADHD who suffer from ADHD, the decision to discontinue medication is difficult if not impossible. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. A decrease in medication could affect the ability to drive safely and complete work-related tasks, which are crucial aspects of everyday life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking medication or stop due to pregnancy, educate their family members, colleagues, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. Educating them can also make the woman feel more comfortable when she is struggling with her decision. It is important to remember that certain medications can pass through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the infant.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. With two massive data sets, researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increase in the risk of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study could not discover any link between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are in the same vein as previous studies that have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before the time of pregnancy. This risk increased during the latter stages of pregnancy, when a lot of women began to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required breathing assistance during birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
Researchers hope their research will inform physicians when they meet pregnant women. The researchers suggest that, while discussing benefits and risks are important, the choice about whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors warn that, while stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and other mental disorders among women who are pregnant or recently gave birth. Additionally, the research suggests that women who decide to stop their medications are more likely to have difficulties adjusting to life without them after the baby's arrival.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to a new routine. This is why many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at a low level. However, the frequency of medication exposure to the newborn may differ based on dosage, how often it is administered, and the time of the day it is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully understood.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must weigh the benefits of keeping her medication against the possible dangers to the embryo. In the meantime, until more information is available, GPs may ask pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication without risk while breastfeeding and during pregnancy. In the end, an increasing number of patients choose to do so, and after consulting with their doctor, they have found that the benefits of keeping their current medication exceed any risk.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder, learn about available treatment options and strengthen existing coping strategies. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if necessary adjustments to the medication regimen.